Predictors of Survival in Atypical Meningiomas

Abstract

Introduction: Predictors of survival and progression of disease in atypical meningiomas are less well documented in the literature compared to benign meningiomas. Higher grade meningiomas tend to recur often and one of the most critical aspects is how to best deal with relapses. Methods: A total of 77 consecutive patients who underwent craniotomy for atypical meningioma between 1990–2010 at Oslo University Hospital (OUH) were reviewed. Results: Median age at surgery was 62.21 [interquartile range (IQR): 22.87] years. Fifty-one patients (66.2%) had neurological deficits at presentation. Fifty-four patients (70.1%) underwent gross total resection (GTR). Thirty-nine patients (50.7%) had improved/stable neurological outcomes at 6–12 months. Twenty-two patients (28.6%) underwent retreatment, of whom 20 (26.0%) were subjected to resection followed by adjuvant radiotherapy. Overall survival (OS) was significantly longer in patients <65 years (p < 0.001), with preoperative Karnofsky performance scale (KPS) score of ≥ 70 (p = 0.006), and who required no retreatment (p = 0.033). GTR significantly prolonged the retreatment-free survival rate (p < 0.001). STR carried almost a six-fold greater risk of neurological outcome deterioration (p = 0.044). Conclusions: GTR significantly prolonged retreatment-free survival but had no significant impact on OS. STR was a significant risk factor for deteriorated neurological outcome. Age, preoperative KPS, and retreatment were all strong predictors of OS. Median time-to-retreatment (TTR) did not shorten significantly throughout repeated surgeries.

A Clinical Prognostic Model Based on Preoperative Hematological and Clinical Parameters Predicts the Progression of Primary WHO Grade II Meningioma

“…Currently, Simpson's removal grade is a parameter that is widely used by neurosurgeons in clinical practice to evaluate the progression risk for meningiomas. Numerous studies have concluded that STR (Simpson grade ≥3) induces early progression of meningiomas (15,16,37), and our results are consistent with this finding. Considering the efficacy and neurotoxicity of radiotherapy, it is still controversial as to whether PORT is necessary as a routine treatment for AM.…”

“…The extent of resection (EOR) was comprehensively evaluated by neurosurgeons based on the surgical records and postoperative MRI reports provided by radiologists. The EOR was divided into gross total resection (GTR) (Simpson grades I–II) and subtotal resection (STR) (Simpson grades III–V) ( 15 ). Skull invasion was considered when the preoperative CT showed that the inner plate of the skull was uneven or when the inner plate was found to be eroded by the tumor during the operation.…”

Establishment and Validation of an Integrated Model to Predict Postoperative Recurrence in Patients With Atypical Meningioma

“…Klinger et al found that tumors located in skull base had a trend towards decreased recurrence in AM (32). However, Da Broi et al identified a tendency towards more retreatment in AM located in skull base (33). Our study revealed that tumor located in skull base was strongly associated with AM recurrence and excluded from confounding factors in the multivariable Cox analysis.…”

Factors Affecting the Outcome of Surgical Management of Atypical Meningiomas

“…According to a recent study, atypical meningiomas are linked with a greater risk of recurrence and shorter overall survival lengths than benign meningiomas (Grade I). Atypical meningioma is linked with a 7-8fold higher risk of recurrence and a 2-fold greater risk of death 3-6 years after diagnosis [5,6] .…”